Long-Term Followup of Anterior Cruciate Ligament Reconstructions Using Freeze-Dried Fascia Lata Allografts

Abstract

We identified 79 patients who underwent arthroscopically assisted intraarticular anterior cruciate ligament reconstruction with freeze-dried fascia lata allografts and an additional lateral extraarticular reconstruction. We were able to contact 62 patients (79%) for follow-up evaluation at an average of 134.5 months. Forty patients (51%) returned for objective evaluation. Lysholm scores at followup averaged 92.3 and Tegner activity scores averaged 5.1. Only four (6%) of the 62 patients contacted reported episodes of full giving way. Thirty (75%) of the 40 patients examined demonstrated 3 mm or less side-to-side difference on KT-1000 arthrometer manual maximum evaluation. Forty-eight (77%) of the 62 patients were participating in sporting activities at final followup. No patient had evidence of graft rejection.

ACL reconstruction with BPTB autograft and irradiated fresh frozen allograft

“…Since then there has been increasing interest in the use of allografts for primary ACL reconstruction, and its role is expanding. There are several published clinical studies (Olson et al, 1992;Pritchard et al, 1995;Siebold et al, 2003;Nyland et al, 2003;Lawhorn and Howell, 2003;Chang et al, 2003;Kustos et al, 2004;Prodromos et al, 2006) evaluating autograft and allograft used in ACL reconstruction, but the findings vary greatly. These discrepancies are due in a large part to the variety of tissues used, and the tremendous variation in surgical technique, fixation, and postoperative protocols.…”

Histologic evaluation of human cadaveric fascia lata in a rabbit vagina model

“…These sites (e.g., knee) are sterile [3][4][5]. We found that some grafts remain colonized with potentially pathogenic bacteria for as long as 12 weeks.…”

“…Histologic examination evaluated graft integrity, amount of neovascularization, host inflammatory response, and host tissue incorporation within the graft. The quantification of these histologic responses has not been standardized in the orthopedic literature [3][4][5]; therefore, individual findings were described. The grafts were embedded in paraffin and serially sectioned (into 4-lm sections) for a total of nine blocks per graft.…”

“…Prior studies, by looking at only one point that was usually at least 12 weeks after implantation, would probably not be able to determine whether the graft was reorganized or replaced. By evaluating ten implanted grafts serially over 12 weeks, we found that the dynamic process of remodeling occurs in an expected fashion and progression [3][4][5][6][7]13] but that it appears to result in replacement of the graft with host tissue rather than in reorganization of the graft tissue.…”

“…In orthopedic procedures, allograft fascia lata appears to offer an equivalent efficacy and a similar histologic response as autologous tissues [3][4][5]. However, results reported in the urogynecologic literature are conflicting, with some studies revealing an unexpectedly high rate of early recurrence of symptoms most likely attributable to graft failure [1,[6][7][8].…”